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Schizophrenic patients with symptoms show more impairment than those without symptoms on an ecologically valid test of executive function.
Rice, C. D., Done, D. J., MANLY, T., & McKenna, P. J.
XIth Biennial Winter Workshop on Schizophrenia, Davos, Switzerland, February 24-March 1, 2002. Schizophrenia Research, 53(3), 133.
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Although executive impairment has been well documented in schizophrenia, whether it is disproportionate to general intellectual impairment, and its relationship to symptoms both remain uncertain. Using the neuropsychological single case study approach, we applied a novel, ecologically valid test of executive function, the Hotel Test, to patients with and without symptoms. The Hotel Test requires the subject to monitor their time, switch between tasks, and keep track of their intentions, in the context of managing an imaginary hotel. Seven patients who were in excellent remission from both positive and negative symptoms, usually as a consequence of treatment with clozapine, were compared with six chronically symptomatic patients. Both groups were individually matched for overall intellectual function, which was well- or relatively well-preserved. Impairment on the Hotel Test was found in both groups. This was irrespective of general intellectual impairment and was seen in some patients with well-preserved intellectual function. Impairment was more frequent and marked in the symptomatic patients. These findings suggest that measuring executive impairment in an ecologically valid way provides a sensitive method of demonstrating a specific or disproportionate executive deficit in schizophrenia. They also suggest that executive impairment may be relevant to the presence of symptoms.